Claims Examiner - Workers Compensation

Maxim Healthcare; Columbia (MD); Hybrid; USD 28,000 - 33,000; Full time

Benefits offered by this job

Health and Wellness benefits

401(k) + Company Match

Paid Time Off

Holidays

Educational Assistance Program

Employee Discount Program

Dental

Vision

Health Advocacy Program

Life Insurance

Pet Insurance

Job summary

Maxim Healthcare in Columbia, MD, is seeking a WC Claims Examiner I to manage workers' compensation claims from intake to resolution. You will work with TPAs, medical providers, attorneys, and colleagues to implement claim handling plans and ensure timely action.

You will monitor files, meet legal deadlines, discuss reserves and settlements with the WC Manager, and contribute to process improvements while delivering excellent customer service to employees.

Qualifications

• Bachelor's degree in business, human resources, or related field preferred.
• At least 3 years of claims handling experience or legal assistance experience supporting claims.
• Legal experience strongly preferred.
• Good organizational skills and attention to detail.

Responsibilities

• Brings pending and new WC claims to resolution.
• Participates in calls with TPAs, medical providers, attorneys, and Maxim team members to agree on plans.
• Monitors TPA files.
• Ensures legal deadlines are met.
• Maintains WC Department Legal Calendar.
• Participates in depositions, mediations, and calls regarding assigned claim files.
• Reviews and comments on the financial aspects of assigned claim files.
• Educates branch offices about workers compensation.
• Provide excellent customer service to all employees.
• Helps identify patterns developing from injuries and resulting in WC claims.
• Helps to track claims and run reports for management.
• Makes recommendations for improving the WC claim process reducing overall claim counts.
• Performs other duties as assigned

Skills

Organizational skills

Independent worker

Customer service

Communication skills

Team player

Education

Bachelor's degree preferred

Tools

Microsoft Office

Job description

Claims Examiner Workers' Comp

Location - Columbia, MD - Hybrid

Pay Range: $20.00 - $24.00 + $4,000 annual bonus potential

The Workers’ Compensation (WC) Claims Examiner I participates in every aspect of the WC claim process. Working independently and in coordination with other WC team members, the WC Examiner I will consult with the WC Manager regarding reserve adjustments, a plan of action, and the appropriate settlement value of assigned claim files. The WC Claims Examiner I also works with the In-take Coordinators, other Claim Examiners in the department, the third party administrator, the WC Manager and fellow Maxim co-workers in the execution of company business.

Essential Duties And Responsibilities

• Brings pending and new WC claims including those that are litigated, to resolution.


• Participates in calls with local offices, third-party administrators (TPAs), medical providers, attorneys, and other Maxim team members, in order to agree upon, communicate, and execute claim handling plans.


• Monitors TPA files.


• Ensures legal deadlines are met.


• Maintains WC Department Legal Calendar.


• Participates in depositions, mediations, and calls regarding assigned claim files.


• Reviews and comments on the financial aspects of assigned claim files.


• Educates branch offices about workers compensation.


• Provide excellent customer service to all employees.


• Helps identify patterns developing from injuries and resulting in WC claims.


• Helps to track claims and run reports for management.


• Makes recommendations for improving the WC claim process reducing overall claim counts.


• Performs other duties as assigned

Minimum Requirements

• Bachelors degree in business, human resources, or related field preferred.


• At least 3 years of claims handling experience or legal assistance experience supporting claims..


• Legal experience strongly preferred.


• Good organizational skills and attention to detail.


• Ability to work in a fast-paced environment.


• Be able to work independently and as part of a team.


• Ability to communicate effectively and provide excellent customer service with individuals both inside and outside of the organization.


• Computer proficiency, including Microsoft Office applications, required.

Maxim Benefits

Health and Wellness

Medical/Prescription, Dental, Vision, Health Advocacy (company paid if enrolled Medical) and Health Advocate Employee Assistance Program

Retirement And Financial Security

Employee Assistance Program, Health Savings Account, 401(k) + Company Match, Profit Sharing, Short and Long Term Disability, Primary Caregiver Leave, Parental Leave, Life and Basic Accidental Death & Dismemberment Insurance, Voluntary Group Life Insurance and Supplemental Accidental Insurance, Hospital Expense Protection Plan, Critical Illness Insurance, Dependent Care Flexible Spending Account, Home and Auto Insurance discounts, Pet Insurance and Legal benefits

Lifestyle Benefits

Paid Time Off and Company Paid Holidays, Transportation Benefits, Educational Assistance Program, College Partnership Program and Employee Discount Program

• Benefit eligibility is dependent on employment status.

About Maxim Healthcare

Maxim Healthcare has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.

Maxim Healthcare, Inc. (“Maxim”) is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected Veteran status, age, or any other characteristic protected by law.